CO2气腔内窥镜下腓肠神经切取术的临床应用

目的介绍CO2注气形成皮下气腔、内窥镜下腓肠神经切取术的方法及其临床应用结果。方法7例周围神经缺损患者，男5例，女2例。神经缺损长度5～8cm，共切取9侧小腿自体腓肠神经移植。在小腿上端腓肠神经走行上作-1．0-1．5cm横切口为腔镜入口，其外侧作-0．5～1.0cm横切口为操作入口。利用腹腔镜系统，通过气腹机注入CO2气体，气压维持在10-15mmHg，形成皮下气腔。于内窥镜下游离并切取腓肠神经，以电缆式移植修复周围神经缺损。结果9侧小腿上腓肠神经均顺利游离和切取，长度为30-42cm，手术时间平均每侧约30min。镜下全段观察腓肠神经未见外膜损伤，切取小段送病理检查，未见神经纤维损伤。术中无碳酸血症和气体栓塞发生，术后小腿无皮下积气、血肿。全部病例随访6-10个月，移植神经功能恢复良好，所支配肌肉肌力恢复至2-4级，感觉恢复至S3-S4级。神经生长速度与传统方法切取腓肠神经移植手术相当。结论CO2气腔内窥镜下腓肠神经切取术操作简单，方法实用，与传统的长直切口、多个阶梯状横切口开放切取腓肠神经手术比较，供区创伤小、美观、恢复快。

Clinical application of endoscopic harvesting the sural nerve in the carbon dioxide gas cavity

Objective To introduce the clinical application and method of endoscopic harvesting the sural nerve in the carbon dioxide gas cavity. Methods 7 cases with peripheral nerve defect were involved, including 5 men and 2 women. The length of nerve defects ranged from 5 to 8 cm, all the nerve defects were repaired by autogenous sural nerve grafting. The sural nerve were removed from 9 calves in 7 cases. Along the course of the sural nerve in the proximal calf, a transverse 1.0 to 1.5 cm incision was done for endoscope approach, another transverse 0.5 to 1.0 cm incision was done lateral to the sural nerve for operation approach. Using abdominoscope system, the sural nerves were cut and removed smoothly in the cavities which were maintained the gas pressure 10 to 15 mm Hg with carbon dioxide insufflation. All the peripheral nerve defects of 7 cases were repaired as cable graft with harvested sural nerve. Results The length of nerve graft harvested from 30 to 42 cm in 9 calves. It took about 30 minutes to harvest the nerve in each side. There was no abvious injuries found by pathologic inspection. No carbonemia and air embolism occurred on patients during operating time, no complications of hypodermic pneumatosis and hematoma occurred on all cases. All patients followed up from 6 to 10 months, the function recovery of the nerves was good. The muscle power was obtained 2 to 4 grade, the sensation was obtained S3 to S4 grade. The function recovered as fast as the traditional operation of sural nerve transfer. Conclusion The method of endoscopic harvesting the sural nerve in the carbon dioxide gas cavity with minimal incision is easy to perform. Compared with the long longitudinal incision and multiple stair-step incision, the method can get less invasive and traumatic, and good aesthetic results. This technique deserves the doctor application in clinical work.